The Courts

Federal Judge Margaret Sweeney issued a final judgment in the class action case Common Ground Healthcare Cooperative v. United States ordering the government to reimburse the class of about 100 Affordable Care Act plan issuers nearly $1.6 billion in cost-sharing reduction payments owed for the 2017 and the 2018 plan years.

The Ninth Circuit Court of Appeals upheld a lower court ruling that barred HHS from enforcing the Trump administration’s rule that allows employers to easily avoid covering birth control without cost-sharing in the 14 plaintiff states.

Stakeholders who cheered a district court ruling that shot down key pieces of the Trump administration’s rule that expanded association health plans are likely to face a steeper challenge in the appeals court where they’ll be arguing before a panel of judges appointed by two GOP presidents and one Democrat.

Federal appellate judges grilled a lawyer for the Trump administration on Friday (Oct. 11) over the administration’s policy allowing states to add work requirements to their Medicaid programs, with all the members of a three-judge panel -- two Democratic appointees and one Republican appointee -- expressing skepticism that work requirements can promote the goals of Medicaid.

The Tenth Circuit Court of Appeals could soon deliver a ruling in the ongoing case on whether HHS wrongly assumed that the Affordable Care Act's risk adjustment program had to be budget neutral, and whether state-wide adoption of that policy means that average premiums in the risk adjustment methodology should stand.

The case to overturn the Trump administration's rule on short-term plans will not be decided until months after the start of the Affordable Care Act next open enrollment period, according to a recently released briefing schedule from the U.S. Court of Appeals for the District of Columbia Circuit.

HHS reduced the backlog of Medicare appeals by about 25% as of June 30, according to a status report submitted to the federal D.C. district court, and the American Hospital Association said that reduction was the result of its lawsuit.

CMS is signaling a continued effort to lower reimbursement for 340B drugs, even as a court suit over the agency’s earlier cuts continues, by collecting hospital data to back up future reimbursement rates.

CMS Administrator Seema Verma said a recent court ruling that found CMS didn’t have the authority to implement site-neutral pay cuts for certain clinic visits was a setback to agency efforts to correct market distortions, and she pushed back on what she called “[e]ndless litigation from entrenched special interests.”